Provider Demographics
NPI:1134494834
Name:MUDEK, AMANDA LYNNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNNE
Last Name:MUDEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 HARVARD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1172
Mailing Address - Country:US
Mailing Address - Phone:504-708-4810
Mailing Address - Fax:
Practice Address - Street 1:2520 HARVARD AVE FL 1
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1172
Practice Address - Country:US
Practice Address - Phone:504-708-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA325550213ES0103X
LA325547213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery